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Suggest Treatment For Liver Failure While Having Cirrhosis
Question: 66 yoF dx with advanced cirrhosis from Hep C contracted in 1970's. Pt. went through anti-viral tx about 3 yrs ago Dec.and has been told she is "clear of Hep C". Pt. had esophageal bleed in Dec, 2010 and varices were banded. Has been told with each endoscopy the varices have "scarred over." Pt. has significant lower extremity swelling with right leg worse swelling than the left. Pt. recently has started noticing "poochy" stomach but is unwilling to say she has ascites. Pt has been dx with pleural effusion, HE on Xifaxan BID. Pt. went without meds for 3 days last month and had problems--shaking and needing meds to resume. Pt. takes Lasix and Spironolactone daily, Xifaxan BID, Lexapro QD, Propanolol 15mg, QD, Coumadin, QD, nausea med, PRN. Pt. is an RN on disability and thinks she is going to recover. Pt. has clubbing, palmar erythema, muscle wasting, appears malnourished and sleeps 16-18 hrs. daily. Last labs done in April along with U/S of abdomen which showed splenomegaly. Bilirubin--2.9; Albumin--3.1; Hgb--10.2; Hct--32.7; Plt--39,000; Serum Protein--5.6; INR-1.7. Her MELD score is 16. She refuses to discuss with family members about her health. My question is with the information I've been able to provide, what would be an estimate of life expectancy. Pts. husband says she moves extremely slowly and has aged markedly in the last six months. All movements are very slow and deliberate and I've told him that is not only the cirrhosis but probably HE has some bearing on that. Any information would be greatly appreciated. Pt. had cholecystectomy done 9/2014 and almost bled out on the table. The surgeon told the husband after the surgery that he saw the liver and that the cirrhosis was "really bad."
Brief Answer:
Six months would be reasonable!
Detailed Answer:
Hi and thank you so much for this query.
I am so sorry to hear about what this patient is going through. This is decompensated liver failure and only a transplant can rescue him. At this time, am pretty sure we are looking at approximately 6months. This is the median and as such she can live a little longer or even fall short of that. It is difficult to talk about this in its entirety but I do hope you understand that this is definitely a difficult information to pass onto some one in relation to a loved one.
I hope this helps. I wish you well. Feel free to ask for more information and clarifications if need be. Above all, thanks for using our services.
Six months would be reasonable!
Detailed Answer:
Hi and thank you so much for this query.
I am so sorry to hear about what this patient is going through. This is decompensated liver failure and only a transplant can rescue him. At this time, am pretty sure we are looking at approximately 6months. This is the median and as such she can live a little longer or even fall short of that. It is difficult to talk about this in its entirety but I do hope you understand that this is definitely a difficult information to pass onto some one in relation to a loved one.
I hope this helps. I wish you well. Feel free to ask for more information and clarifications if need be. Above all, thanks for using our services.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your thorough response. I knew when I sent the information last night I was going to leave out possible pertinent information and I did. Pt. also takes Prilosec 40mg, BID and Ultram 50mg, Q4H,PRN. She has been jaundiced in the past but, at this point, is an ashen-gray color. She also has significant hair loss. When she does have a good day, she may be up for several hours and do a little laundry or a little cooking but then back to bed. After she has had a good day, she will probably be in bed for 3-5 days thereafter.
She has been on Levaquin twice since XXXXXXX , 2016 for UTI and has been on a course of Prednisone for pruritis.
During February and March of this year, she had significant difficulties with her finances and her husband had to pay some of her expenses because she ran out of money. I told him this was due to HE and he may need to "take over" but he is unwilling to do that at this point.
She is to see her hepatologist later this month as she is still on liver transplant list. However, husband is well aware of the fact that with her age and blood type O and a MELD of 16, she is unlikely to receive a transplant. He keeps telling me he doesn't see her living too much longer but HE doesn't have much to base that on except the way she is looking. Since he has been kept "out of the loop" with all her medical information, he is basing that idea on how she looks only along with information that I have been able to give him. What she tells him is that she is "regenerating liver cells and going to live to be an old lady." I saw her in January myself and don't see how that can happen but have done a tremendous amount of research since then and been able to give him information concerning cirrhosis. He says what I tell him makes more sense that what she tells him just based on what the surgeon told him ("really bad cirrhosis") and what he sees.
I don't know that this information will give you enough added details to make your decision a little different. Oh, I also forgot to tell you. I know a lot of patients in a terminal disease will do things strange for their normal behavior. Last Christmas, this patient went completely overboard with gift buying--husband says she "went nuts". I told him she possibly did that because she didn't expect to be alive another Christmas--or could have been the HE making her do dumb things.
Thank you again for your response and I appreciate any information you can give me. Husband is planning of going with her to next appt. with Dr. if he can get off of work. When he told her that, I think her attitude has changed a little and she has become even more closed off. Don't know but wonder if she is dreading the husband finding out how bad she really it.
She has been on Levaquin twice since XXXXXXX , 2016 for UTI and has been on a course of Prednisone for pruritis.
During February and March of this year, she had significant difficulties with her finances and her husband had to pay some of her expenses because she ran out of money. I told him this was due to HE and he may need to "take over" but he is unwilling to do that at this point.
She is to see her hepatologist later this month as she is still on liver transplant list. However, husband is well aware of the fact that with her age and blood type O and a MELD of 16, she is unlikely to receive a transplant. He keeps telling me he doesn't see her living too much longer but HE doesn't have much to base that on except the way she is looking. Since he has been kept "out of the loop" with all her medical information, he is basing that idea on how she looks only along with information that I have been able to give him. What she tells him is that she is "regenerating liver cells and going to live to be an old lady." I saw her in January myself and don't see how that can happen but have done a tremendous amount of research since then and been able to give him information concerning cirrhosis. He says what I tell him makes more sense that what she tells him just based on what the surgeon told him ("really bad cirrhosis") and what he sees.
I don't know that this information will give you enough added details to make your decision a little different. Oh, I also forgot to tell you. I know a lot of patients in a terminal disease will do things strange for their normal behavior. Last Christmas, this patient went completely overboard with gift buying--husband says she "went nuts". I told him she possibly did that because she didn't expect to be alive another Christmas--or could have been the HE making her do dumb things.
Thank you again for your response and I appreciate any information you can give me. Husband is planning of going with her to next appt. with Dr. if he can get off of work. When he told her that, I think her attitude has changed a little and she has become even more closed off. Don't know but wonder if she is dreading the husband finding out how bad she really it.
Brief Answer:
It is not uncommon!
Detailed Answer:
Hi,
I uderstand clients in denial often do such things. Telling her husband she will be able to live to become an old lady is really off the radar. Well, illness is really responsible for all this. Unfortunately, unless she gets a liver transplant, her days are not that too many. It is sad but then I have reviewed this added details and there is really nothing much to hang unto except with a transplant. I pray hard she gets one sometime soon to reshape the future.
I hope this helps. I wish you well. Feel free to follow up for more exchanges.
It is not uncommon!
Detailed Answer:
Hi,
I uderstand clients in denial often do such things. Telling her husband she will be able to live to become an old lady is really off the radar. Well, illness is really responsible for all this. Unfortunately, unless she gets a liver transplant, her days are not that too many. It is sad but then I have reviewed this added details and there is really nothing much to hang unto except with a transplant. I pray hard she gets one sometime soon to reshape the future.
I hope this helps. I wish you well. Feel free to follow up for more exchanges.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
In several medical articles that I have read, there has been evidence of large varices present IF the spleen is enlarged AND platelets are below 50,000. Is there any basis to this? This patient is to have her routine yearly endoscopy done sometime later this month and then follow-up with her hepatologist.
She told her husband in the middle of the night last week that she was taking "way too many pain pills" but I don't know how many she is taking (Ultram). She has also been taking Benadryl nightly for a while to help her sleep. I don't know why when she sleeps as much as she does. I spoke with the husband a few minutes ago and he stated that she looks really old and not good today.
Thank you again for your response. I'm hoping I don't have anything else to add
after this correspondence. I really appreciate your attention and responses.
She told her husband in the middle of the night last week that she was taking "way too many pain pills" but I don't know how many she is taking (Ultram). She has also been taking Benadryl nightly for a while to help her sleep. I don't know why when she sleeps as much as she does. I spoke with the husband a few minutes ago and he stated that she looks really old and not good today.
Thank you again for your response. I'm hoping I don't have anything else to add
after this correspondence. I really appreciate your attention and responses.
Brief Answer:
See below!
Detailed Answer:
Hi,
This is because by the time there are varices, the back pressure is sufficiently high that there is blood accumulation in the spleen as well leading to splenomegaly. Because the spleen destroys platelets, these persons most often have low platelets. I understand this is clearly not easy and I wish you well.
See below!
Detailed Answer:
Hi,
This is because by the time there are varices, the back pressure is sufficiently high that there is blood accumulation in the spleen as well leading to splenomegaly. Because the spleen destroys platelets, these persons most often have low platelets. I understand this is clearly not easy and I wish you well.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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